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Document Sample
ne
De v r
a e : RN ,I OU , I &B IG WI Y !
L
•P g 1 P ITF L TS GN RN H
T OU
a e :ce u n i i
e men
•P g 2 S h d l a dt le
ae : p i t s
e o
•P g 3 Ma &Drcin
a e : J l a a l” re & nomai
B z
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a e : wa a nomai
•P g 5 S gB gIfr t n o
RN Y R I E OF E E TRT C
C E RN T OU
H
P IT OU T K T F V N B I . OM &B IG WI Y !
Please
pre-‐fill
out
ONE
form
for
each
baby/toddler
and
BRING
WITH
YOU
ON
THE
MORNING
OF
THE
EVENT
THE
GREAT
CLOTH
DIAPER
CHANGE:
DENVER
Event
Date:
Saturday,
April
23,
2011
Event
Start
Time:
10:00am
-‐
Please
try
to
arrive
NO
LATER
then
9:45
am
Event
Location:
Berkeley
Park
&
Scheitler
Recreation
Center
5031
W.
46th
Ave.
Denver
CO
80212
Telephone:
303-‐279-‐3864
E-‐Mail:
info@kanga-‐care.com
Due
to
space
constraints,
pre-‐registration
is
advised.
If
space
is
available
on
day
of
event,
onsite
registration
will
be
accepted
but
cannot
be
guaranteed.
EVENT
RULES
There
are
a
few
rules
to
keep
in
mind:
1.
Arrive
on
time!
2.
For
this
record,
each
baby
must
be
changed
from
a
cloth
or
disposable
diaper
into
a
reusable
cloth
diaper
that
must
be
able
to
be
purchased
online
or
in
a
retail
store.
Unfortunately,
homemade
diapers
that
are
not
commercially
available
cannot
be
used.
This
is
a
very
strict
rule
from
Guinness
World
RecordsTM.
3.
All
babies
and
toddlers
must
be
39
inches
or
shorter.
4.
Each
baby
must
be
paired
with
exactly
one
adult
participant.
DONATIONS
If
you
would
like
to
make
a
donation
to
the
Real
Diaper
Association,
the
501(c)(3)
nonprofit
organization
dedicated
to
spreading
the
word
about
reusable
cloth
diapers,
you
may
do
so
at
the
event.
Donations
are
NOT
MANDETORY
this
is
a
FREE
EVENT.
All
donations
are
tax
deductable
and
you
will
be
provided
with
a
receipt.
INFORMATION
About
Adult
Name
_______________________________________________________________________________________________
Street
Address
________________________________________________________________________________________
City
__________________________________________State
________________
Zip
_______________________________
Telephone
________________________________
Email
______________________________________________________
About
Baby
Name
___________________________
Date
of
Birth:
_____________
Height
of
Baby
(inches):
_________
Brand
and
Style
of
Cloth
Diaper
Being
Used:
___________________________________________________
Don’t
have
a
cloth
diaper
but
want
to
participate?
No
problem!
Cloth
diapers
will
be
available
for
purchase
on-‐site
for
25%
off
retail.
One
per
participant
allowed.
Brand
and
style:
“Rum•p•arooz
One
Size
Pocket
Diaper.”
•
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•
WAIVER
OF
LIABILITY
AND
MEDIA
RELEASE
AGREEMENT
During
my
participation
in
activities
before,
during
and
after
The
Great
Cloth
Diaper
Change
on
April
23,
2011
at
th
Berkeley
&
Scheitler
Recreation
Center
located
on
5031
W.
46
Ave
Denver
CO
80212:
1. I
understand
the
risk
of
injury
during
my
participation
in
The
Great
Cloth
Diaper
Change
and
further
agrees
that
I
assumes
full
responsibility
for
my
own
safety
and
for
the
safety
of
my
children
and
for
determining
that
no
dangerous
conditions
exist
that
could
affect
our
own
safety;
2. I
understand
that
in
the
course
of
our
participation
in
The
Great
Cloth
Diaper
Change,
video
or
photographs
may
be
taken
or
illustrations
may
be
made
of
me
and
my
child
and
further
agree
to
allow,
without
compensation,
my
and
my
child’s
likeness
to
appear
in
material,
regardless
of
media
form,
promoting
The
Great
Cloth
Diaper
Change,
its
events
and
activities,
including
those
of
its
representatives
and
licensees;
3. I
understand
that
there
will
be
no
financial
or
other
compensation
for
photographing/videoing
my
child
or
me.
4. I
represent
that
I
am
at
least
18
years
of
age,
have
read
and
understand
the
foregoing
statement,
and
am
competent
to
execute
this
agreement.
Signature:________________________________________________________
Date:_______________________________
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